New in the Literature: Postacute Care Site on Stroke Outcomes (Arch Phys Med Rehabil. 2013;94(4):622-629.)

Wednesday, April 03, 2013

New in the Literature: Postacute Care Site on Stroke Outcomes (Arch Phys Med Rehabil. 2013;94(4):622-629.)

Patients with stroke may make more
functional gains if their postacute care includes treatment received at an inpatient
rehabilitation facility (IRF), say authors of an article published this month in Archives
of Physical Medicine and Rehabilitation. This finding may have important
implications as postacute care delivery is reshaped through health care reform,
they add.

Researchers conducted this prospective
cohort study at 4 northern California hospitals that are part of a single
health maintenance organization. They enrolled patients with stroke (N=222)
between February 2008 and July 2010.

Baseline and 6-month assessments
were performed using the Activity Measure for Post Acute Care (AM-PAC), a test
of self-reported function in 3 domains: basic mobility, daily activities, and applied
cognition.

Of the 222 patients analyzed, 36%
went home with no treatment, 22% received home health/outpatient care, 30%
included an IRF in their care trajectory, and 13% included a skilled nursing
facility (but not IRF) in their care trajectory. At 6 months, after controlling
for variables such as age, functional status at acute care discharge, and total
hours of rehabilitation, patients who went to an IRF had functional scores that
were at least 8 points higher (twice the minimally detectable change for the
AM-PAC) than those who went to a skilled nursing facility in all 3 domains and
in 2 of 3 functional domains compared with those who received home
health/outpatient care.